Provider Demographics
NPI:1851624191
Name:PETERBURS, AMY (MSAT, LPC-IT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:PETERBURS
Suffix:
Gender:F
Credentials:MSAT, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10922 N CEDARBURG RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-4304
Mailing Address - Country:US
Mailing Address - Phone:262-242-3810
Mailing Address - Fax:262-242-3816
Practice Address - Street 1:10922 N CEDARBURG RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-4304
Practice Address - Country:US
Practice Address - Phone:262-242-3810
Practice Address - Fax:262-242-3816
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health